The urogenital and rectal pain syndromes.
Pain syndromes of the urogenital and rectal area are well described but poorly understood and underrecognized focal pain syndromes. They include vulvodynia, orchialgia, urethral syndrome, penile pain, prostatodynia, coccygodynia, perineal pain, proctodynia and proctalgia fugax. The etiology of these focal pain syndromes is not known. A specific secondary cause can be identified in a minority of patients, but most often the examination and work-up remain unrevealing. Although these patients are often depressed, rarely are these pain syndromes the only manifestation of a psychiatric disease. This review article presents an overview of the neuroanatomy of the pelvis, which is a prerequisite to trying to understand the chronic pain syndromes in this region. We then discuss the clinical presentation, etiology and differential diagnosis of chronic pain syndromes of the urogenital and rectal area and review treatment options. The current knowledge of the psychological aspects of these pain syndromes is reviewed. Patients presenting with these pain syndromes are best assessed and treated using a multidisciplinary approach. Currently available treatment options are empirical only. Although cures are uncommon, some pain relief can be provided to almost all patients using a multidisciplinary approach including pain medications, local treatment regimens, physical therapy and psychological support, while exercising caution toward invasive and irreversible therapeutic procedures. Better knowledge of the underlying pathophysioloigical mechanisms of the urogenital and rectal pain syndromes is needed to allow investigators to develop treatment strategies, specifically targeted against the pathophysiological mechanism.
Wesselmann
Ursula
U
Department of Neurology, The Johns Hopkins University School of Medicine, 720 Rutland Avenue, Baltimore, MD 21287, USA Department of Urology, The Johns Hopkins University School of Medicine, Brady Urological Institute, Baltimore, MD 21287, USA Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
Burnett
Arthur L
AL
Heinberg
Leslie J
LJ
D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D052776:Female Urogenital Diseases / Q000150:complications*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D052801:Male Urogenital Diseases; D010146:Pain / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D059408:Pain Management; D010388:Pelvis / Q000294:innervation*; D012002:Rectal Diseases / Q000150:complications*; D013577:Syndrome